Provider Demographics
NPI:1205323375
Name:HOOVEN, JERRIKA
Entity type:Individual
Prefix:
First Name:JERRIKA
Middle Name:
Last Name:HOOVEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9913 MAHAFFEY GRAMPIAN HWY
Mailing Address - Street 2:
Mailing Address - City:GRAMPIAN
Mailing Address - State:PA
Mailing Address - Zip Code:16838-8704
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:502 E HOWARD ST
Practice Address - Street 2:
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823-2128
Practice Address - Country:US
Practice Address - Phone:814-355-6777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-15
Last Update Date:2018-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC014289225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist